This proposal represents continued collaboration of two groups at UCSD with an interest in pulmonary rehabilitation for patients with chronic lung diseases and the evaluation of health outcomes. Multidisciplinary, comprehensive pulmonary rehabilitation has been established as a means of enhancing standard therapy to control and alleviate symptoms, optimize functional capacity, and reduce the large medical and economic burdens of these patients. The project proposed is a natural extension of a randomized clinical trial completed successfully over the past 8 years. Overall objectives are to evaluate the effectiveness and cost/utility of pulmonary rehabilitation for patients with disabling chronic obstructive pulmonary disease (COPD). Specific aims are to: 1) evaluate quality of life instruments as outcome measures; 2) assess the importance of maintenance sessions on long-term benefits after rehabilitation; and 3) assess the influence of patient recruitment activities on perception of health status prior to enrollment. 160 patients with COPD will participate in an 8 week, 12 session rehabilitation program followed by one of two randomly assigned follow-up programs: routine (home) care with or without regularly scheduled maintenance sessions for one year. The purposes of the maintenance sessions are to: 1) provide reinforcement of the home care program; 2) maintain group support; 3) encourage compliance; and 4) assist with adjustments due to intervening medical illnesses or other barriers to compliance. Outcome measures obtained at baseline and four additional times over two years include tests of physiologic and psychosocial function as well as overall quality of life. Physiological measures include tests of lung function, exercise tolerance, and rest and exercise gas exchange. Psychosocial measures include questionnaires to assess depression (CES-D), self-efficacy, two measures of shortness of breath, and global perception of health status. Utilization of health care services will be obtained from questionnaire. Quality of life will be assessed with several standard instruments. We expect that this study will provide important information that will improve our understanding of the optimal structure, outcomes, and cost- utility of such programs.